Pain Article: Pain Relief and Emergency Rooms

SAN ANTONIO, TX, United States (UPI) -- Patients who visit hospital emergency rooms for treatment of out-of-control pain frequently find that you can`t spell relief 'E-R', according to recent studies.

'The results of these studies show that persistent pain is common and substantial after emergency department discharge,' said Knox Todd, director of the Pain and Emergency Medicine Institute at Beth Israel Medical Center in New York.

'We, as emergency room doctors, do not do a good job at treating the patients who come in our doors,' Todd told United Press International as he presented a pair of studies that examined what happened to patients seeking help for their pain.

In one study, a survey taken online, only 36 percent of patients who appeared at the emergency room in severe pain were examined within one hour. About 47 percent of the people in the survey defined their visit to the ER as 'poor,' 'terrible' or 'the worst experience of my life.'

In the second study, clinicians at 20 hospitals in the United States and Canada interviewed 842 patients after their discharge from an emergency-room visit. They said that 40 percent of the people who arrived in pain left in pain because they were under-treated, untreated or ignored.

'I`m not surprised at all by these reports,' said Samuel McLean, assistant professor of emergency medicine at the University of Michigan in Ann Arbor. 'There is a lack of education and a lack of understanding among emergency room physicians about pain. You can`t look at someone and know what kind of pain they have.

'ER doctors are used to seeing broken bones and heart attacks and recognizing these people are hurting,' McLean told UPI. 'When they see someone with persistent chronic lower back pain who is a minority, not well dressed, without insurance, the doctors becomes suspicious and the first thought is not that the person is in agony, but that he or she is looking to abuse medication.' McLean did not participate in the studies but concurred with their findings.

In the papers presented Friday at the annual meeting of the American Pain Society in San Antonio, Todd and colleagues also reported:

-- About 21 percent of patients said they waited more than three hours in the emergency department for doctors to see them.

-- About 25 percent said the ER doctor believed them when they explained they had out-of-control pain, the reason 88 percent of the people with pain went to the hospital.

-- About 15 percent of ER experiences resulted in doctors taking immediate action. More than 30 percent of the time the patients said the ER doctors 'didn`t believe my pain.'

-- In the survey 47 of the patients went to the emergency room because they said their primary care physician would no longer treat them, mainly because the doctor was concerned that he was already giving the patient a high dose of opioids or that the doctor said 'he had done all he could do.'

-- About 44 percent of the patients said they felt they were treated with dignity.

Penny Cowan, founder and executive director of the American Chronic Pain Association, said she hopes the Internet-based study will help prompt more research into the area and result in education of both doctors and patients about chronic pain and the role both doctor and patient have in controlling it.

'This preliminary survey highlights the many challenges faced by those seeking relief from chronic pain,' she told UPI. 'There is a marked mismatch between patient expectations and the emergency department treatment of pain.'

Todd agreed. 'Further research is needed to assess if more aggressive analgesic treatment during the emergency department stay may provide better pain-related outcomes after discharge,' he said.